Table 2.

Patients’ classification, according to treatment perspective (IIIB)

Patients’ classification	Factors
Patient suitable for chemotherapy treatment without limitations	The presence of ALL the following factors  ECOG 0–1  Age ≤75 years  Bilirubin ≤1.5 ULN  Good nutritional status (serum albumin >2.5 mg/dl, weight lost <10% over the last 3–6 months and BMI >20 kg/m2)  Lack of co-morbidities
Patient suitable for chemotherapy with limitations	The presence of AT LEAST ONE of the following factors  ECOG 2 (which can lead to KPS 70%)  Age >75 years  Mild to moderate neurological or endocrine-metabolic organ dysfunction; in case of liver dysfunction, hyperbilirubinemia >1.5 × ULN (once optimized if obstructive causes are present, for example with biliary stent) marks the degree of dysfunction. It is considered appropriate to adjust the dose, for example, using GEM at 600-800 mg/m2 and nab paclitaxel 75–100 mg/m2) [37]  Cardiac dysfunction, especially a recent ischemic event; acute, symptomatic, severe TED such as PE with hemodynamic instability or DVT with risk and limb amputation [38] BMI <20 kg/m2 or >10% weight loss in 3–6 months
Patient not suitable for chemotherapy treatment	The presence of AT LEAST ONE of the following factors  ECOG 3-4 (which may result in KPS ≤ 60%). Active treatment will be initiated in patients with ECOG 3 secondary to the disease (not to their previous comorbidities) without any severe organ dysfunction, thus moving this subgroup of patients to the “candidate for chemotherapy treatment with limitations” group  Severe organ dysfunction: neurological (e.g., severe cognitive impairment, Alzheimer’s type); endocrine-metabolic, infectious (uncontrolled HIV), renal, hepatic dysfunctions, etc

ECOG Eastern Cooperative Oncology Group, ULN upper normal limit, BMI body mass index, GEM gemcitabine, KPS Karnofsky performance status, TED thromboembolic disease, PE pulmonary embolism, DVT deep venous thrombosis